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Eur J Cardiothorac Surg 1998;13:78-83
© 1998 Elsevier Science NL

Experimental development of an electrically stimulated biological skeletal muscle ventricle for chronic aortic counterpulsation¹

^a Department of Plastic and Reconstructive Surgery, Medical School, University of Vienna, Vienna, Austria
^b Department of Biomedical Engineering, Medical School, University of Vienna, Vienna, Austria
^c Institute of Anatomy, Department III, Medical School, University of Vienna, Vienna, Austria
^d Department of Cardio-Thoracic Surgery, Medical School, University of Vienna, Vienna, Austria
^e Center for Biomedical Research, Ludwig Boltzmann Institute for Cardiosurgical Research, Medical School, University of Vienna, Vienna, Austria

Received 14 April 1997; received in revised form 20 October 1997; accepted 29 October 1997.

Corresponding author. Present address. Department of Reconstructive and Plastic Surgery, Clinic of Surgery, University of Vienna, Vienna General Hospital, Währinger Gürtel 18–20, A-1090 Vienna, Austria. Tel.: +43 1 404005620; fax: +43 1 404005640.

Objective: The chronic shortage of donor organs for cardiac transplantation and the high costs for mechanical assist devices demand the development of alternative cardiac assist devices for the treatment of severe heart failure. Cardiac assistance by stimulated skeletal muscles is currently investigated as such a possible alternative. The goal of the presented study was to construct a newly designed biological skeletal muscle ventricle and to evaluate its possible hemodynamic efficacy in an acute sheep model. Methods: A total of 14 adult sheep were used for acute experiments. The entire thoracic aorta including the aortic root was excised from a donor sheep. An aorto-pericardial pouch conduit (APPC) was created by enlarging the aortic circumference in its middle section with two strips of pericardium. This biological conduit was anastomosed in parallel to the descending aorta of a recipient sheep, using the aortic root as an inflow valve to the conduit. Stimulation electrodes were applicated to the thoracodorsal nerve and the latissimus dorsi muscle was detached from the trunk and wrapped around the pouch. ECG-triggered functional electrical stimulation was applied during cardiac diastole to simulate aortic counterpulsation. Stimulation was performed during various hemodynamic conditions. Results: A standardised surgical procedure suitable for long term studies was established during six experiments. An APPC, with 70–80 mm filling volume, was found to be of optimal size. In another eight experiments, hemodynamic measurements were performed. Under stable hemodynamic conditions the stimulation of the biological skeletal muscle ventricle induced a significant increase of mean arterial pressure by 14% and mean diastolic pressure by 26%. During pharmacologically induced periods of cardiac failure, the stimulation of the APPC increased mean arterial pressure by 13% and mean diastolic pressure by 19%. In all eight experiments, the diastolic peak pressure reached supra-systolic values during stimulation. Conclusions: The results demonstrate the hemodynamic efficacy of this newly designed biological skeletal muscle ventricle as an aortic counterpulsation device. Chronic experiments using a preconditioned fatigue-resistant muscle will further help to evaluate its possible clinical significance.

Key Words: Circulatory assist • Aortic counterpulsation • Skeletal muscle ventricle • Functional electrical stimulation • Animal experiment

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